Calcium-Channel Blockers in Hypertensive Patients

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Questions and Answers

True or false: Hypertension is defined as a sustained systolic blood pressure of greater than 140 mm Hg or a sustained diastolic blood pressure of greater than 90 mm Hg?

True

True or false: Sustained arterial hypertension damages blood vessels in the kidney, heart, and brain, leading to an increased incidence of renal failure, coronary disease, heart failure, stroke, and dementia?

True

True or false: Effective pharmacologic lowering of blood pressure has been shown to prevent damage to blood vessels and to substantially reduce morbidity and mortality rates?

True

True or false: There are six main drug classes recommended for the treatment of hypertension?

False Signup and view all the answers

ACE inhibitors are added after improving the treatment with diuretics

True Signup and view all the answers

Beta blockers are added after improving ACE inhibitors or treatment

True Signup and view all the answers

Aldosterone antagonists and fixed doses of hydralazine and isosorbide dinitrate are started in patients who continue to have symptoms despite optimal doses of ACE inhibitors and beta blockers

True Signup and view all the answers

Once a patient has taken the optimal dose of ACE inhibitor and still experiences symptoms, either can be replaced with sacubitril/valsartan

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Digoxin and ivabradine are added to achieve symptomatic benefit only in patients undergoing optimal drug therapy for high frequency rate

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ACE inhibitors are not added after improving the treatment with diuretics

False Signup and view all the answers

Beta blockers are not added after improving ACE inhibitors or treatment

False Signup and view all the answers

Aldosterone antagonists and fixed doses of hydralazine and isosorbide dinitrate are not started in patients who continue to have symptoms despite optimal doses of ACE inhibitors and beta blockers

False Signup and view all the answers

ACE inhibitors and ARBs are two classes of drugs used to treat hypertension and heart failure.

True Signup and view all the answers

ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, resulting in decreased blood pressure and decreased salt and water retention.

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ARBs block the action of angiotensin II at its receptor, thus decreasing blood pressure and decreasing salt and water retention.

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Renin inhibitors act earlier in the renin-angiotensin-aldosterone system than ACE inhibitors or ARBs.

True Signup and view all the answers

ACE inhibitors are primarily eliminated by the kidneys.

False Signup and view all the answers

ARBs are fetotoxic.

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Renin inhibitors directly inhibit angiotensin II.

False Signup and view all the answers

ACE inhibitors, ARBs, and renin inhibitors are safe to use during pregnancy.

False Signup and view all the answers

ARBs are a more attractive therapy for hypertensive diabetics due to their higher nephrotoxicity compared to ACE inhibitors.

False Signup and view all the answers

Enalaprilat is the only drug in the class of ACE inhibitors available intravenously.

True Signup and view all the answers

Losartan is the prototypic ARB, and there are six other ARBs currently available: Valsartan, Telmisartan, Losartan, Irbesartan, Azilsartan, and Olmesartan.

False Signup and view all the answers

β-blockers are primarily used in hypertensive patients with heart disease, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, and chronic heart failure

True Signup and view all the answers

ACE inhibitors and ARBs are used in the treatment of acute coronary syndrome, including acute myocardial infarction and unstable angina pectoris.

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Conditions that discourage β-blocker use include reversible bronchospastic diseases, second- and third-degree heart block, and severe peripheral vascular disease

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Propranolol undergoes extensive first-pass metabolism and may take several weeks to develop full effects

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β-blockers may cause bradycardia, CNS side effects (fatigue, lethargy, insomnia, hallucinations), and hypotension

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Prazosin, doxazosin, and terazosin competitively block $α_1$ adrenoceptors, decreasing peripheral vascular resistance and lowering arterial blood pressure

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Direct-acting smooth muscle relaxants like hydralazine and minoxidil dilate blood vessels

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Heart failure is classified into four stages, and treatment varies from diuretics for volume overload to polytherapy for persistent symptoms

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Minoxidil treatment can cause hypertrichosis and is used topically for male pattern baldness

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In heart failure patients on optimal therapy, Sacubitril/valsartan, digoxin, and Ivabradine may be added for symptomatic benefit

True Signup and view all the answers

True or false: Calcium channel blockers (CCBs) are not recommended for hypertensive patients with diabetes or angina.

False Signup and view all the answers

True or false: High doses of short-acting CCBs should be avoided due to increased risk of myocardial infarction.

True Signup and view all the answers

True or false: Verapamil is the only member of the Benzothiazepines class approved in the US.

False Signup and view all the answers

True or false: Dihydropyridines have a much greater affinity for heart calcium channels than vascular calcium channels.

False Signup and view all the answers

True or false: Most CCBs have long half-lives, making them suitable for once-daily dosing.

False Signup and view all the answers

True or false: Adverse effects of CCBs include constipation, dizziness, headache, and fatigue.

True Signup and view all the answers

True or false: Verapamil should be avoided in patients with congestive heart failure or atrioventricular block due to its positive inotropic effect.

False Signup and view all the answers

True or false: β-Blockers are not a treatment option for hypertensive patients with concomitant heart disease or heart failure.

False Signup and view all the answers

True or false: β-Blockers primarily decrease blood pressure by reducing peripheral vascular resistance.

False Signup and view all the answers

ACE inhibitors block the ACE enzyme responsible for producing the vasoconstrictor angiotensin II and decrease aldosterone secretion, leading to decreased sodium and water retention.

True Signup and view all the answers

Common side effects of ACE inhibitors include dry cough, rash, fever, altered taste, hypotension, and hyperkalemia.

True Signup and view all the answers

ACE inhibitors, ARBs, beta-blockers, CCBs, and diuretics work by different mechanisms to reduce blood pressure and improve cardiovascular health.

True Signup and view all the answers

The benefits of ACE inhibitors, ARBs, beta-blockers, CCBs, and diuretics in managing blood pressure far outweigh the risks, even in patients with chronic kidney disease.

True Signup and view all the answers

ACE inhibitors, such as Enalapril, Captopril, and Lisinopril, are recommended as first-line treatment for hypertension in patients with a high risk of coronary disease, diabetes, stroke, heart failure, myocardial infarction, or chronic kidney disease.

True Signup and view all the answers

Medications that lower blood pressure prevent damages to the kidneys, heart, brain, and other organs leading to conditions such as chronic kidney disease, heart failure, and strokes.

True Signup and view all the answers

Various classes of drugs are available for blood pressure management.

True Signup and view all the answers

Mlm Zebq (a type of mineral oil) can cause damage to the kidneys, heart, brain, and other organs leading to conditions such as chronic kidney disease, heart failure, and strokes.

False Signup and view all the answers

Persistent low or high blood pressure can cause damage to the kidneys, heart, brain, and other organs leading to conditions such as chronic kidney disease, heart failure, and strokes.

True Signup and view all the answers

ARBs, beta-blockers, CCBs, diuretics, and other groups of drugs are also recommended for the treatment of hypertension.

True Signup and view all the answers

The choice of medication for hypertension is based on its proven ability to reduce blood pressure, evidence from placebo-controlled studies that they reduce cardiovascular events, and evidence of broad equivalence on overall cardiovascular morbidity and mortality.

True Signup and view all the answers

High doses of short-acting CCBs should be avoided due to increased risk of myocardial infarction.

True Signup and view all the answers

What are the two traditional classifications of acid-base disturbances?

pH disturbance and aetiology Signup and view all the answers

Which acid is known as a volatile acid, capable of escaping as a gas?

CO2 Signup and view all the answers

In respiratory acidosis, what may cause hypoventilation?

Depression of the respiratory centre Signup and view all the answers

What are the four classes of acid-base disorders?

Respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic alkalosis Signup and view all the answers

Which condition may result in hypercapnoeic acidosis due to decreased alveolar ventilation and PaCO2 >6.0?

Flail chest Signup and view all the answers

In anaesthesia, hypercapnoeic acidosis may also occur due to:

Insufflation of CO2 in laparoscopic surgery Signup and view all the answers

What term is used when the kidneys increase HCO3 reabsorption to compensate for persistent respiratory acidosis?

Metabolic compensation Signup and view all the answers

Which condition may lead to raised plasma HCO3 concentration (>26 mmol/L)?

Obesity hypoventilation syndrome Signup and view all the answers

What characterizes metabolic acidosis?

Low plasma HCO3 concentration Signup and view all the answers

What leads to metabolic acidosis with low plasma HCO3 concentration?

Increased CO2 production Signup and view all the answers

Which group of medications work by different mechanisms to reduce blood pressure and improve cardiovascular health?

ACE inhibitors and ARBs Signup and view all the answers

What class of drugs are recommended as first-line treatment for hypertension in high-risk patients?

ACE inhibitors Signup and view all the answers

'ARBs' block the action of which substance at its receptor to decrease blood pressure and salt and water retention?

Angiotensin II Signup and view all the answers

What medication can cause hypertrichosis and is used topically for male pattern baldness?

Minoxidil Signup and view all the answers

What drug class competitively blocks $α_1$ adrenoceptors, decreasing peripheral vascular resistance and lowering arterial blood pressure?

Prazosin Signup and view all the answers

What characterizes metabolic acidosis?

Low plasma HCO3 concentration Signup and view all the answers

What condition may result in hypercapnoeic acidosis due to decreased alveolar ventilation and PaCO2 >6.0?

Respiratory acidosis Signup and view all the answers

Which group of medications work by different mechanisms to reduce blood pressure and improve cardiovascular health?

ACE inhibitors and ARBs Signup and view all the answers

What are the two traditional classifications of acid-base disturbances?

Acidosis and alkalosis Signup and view all the answers

What may cause hypercapnoeic acidosis with PaCO2 >6.0?

Gullian Bare Syndrome (GBS) Signup and view all the answers

What term is used when the kidneys increase HCO3 reabsorption to compensate for persistent respiratory acidosis?

Metabolic acidosis Signup and view all the answers

What characterizes metabolic acidosis?

Low plasma HCO3 concentration Signup and view all the answers

Which condition may lead to raised plasma HCO3 concentration (>26 mmol/L)?

Obesity hypoventilation syndrome Signup and view all the answers

What may cause hypoventilation in respiratory acidosis?

Myasthenia Gravis (MG) Signup and view all the answers

What leads to metabolic acidosis with low plasma HCO3 concentration?

Increased CO2 production in malignant hyperpyrexia Signup and view all the answers

What medication can cause hypertrichosis and is used topically for male pattern baldness?

Minoxidil Signup and view all the answers

True or false: Sustained arterial hypertension damages blood vessels in the kidney, heart, and brain, leading to an increased incidence of renal failure, coronary disease, heart failure, stroke, and dementia?

True Signup and view all the answers

What are the four classes of acid-base disorders?

Respiratory acidosis, metabolic alkalosis, respiratory alkalosis, metabolic acidosis Signup and view all the answers

Which acid is known as a volatile acid, capable of escaping as a gas?

Carbonic acid Signup and view all the answers

What term is used when the kidneys increase HCO3 reabsorption to compensate for persistent respiratory acidosis?

Metabolic acidosis Signup and view all the answers

What may cause hypercapnoeic acidosis with PaCO2 >6.0?

COPD (Chronic obstructive airway disease) Signup and view all the answers

Study Notes

Calcium channel blockers (CCBs) are recommended for hypertensive patients with diabetes or angina.
High doses of short-acting CCBs should be avoided due to increased risk of myocardial infarction.
CCBs are divided into three chemical classes: Diphenylalkylamines (Verapamil), Benzothiazepines (Diltiazem), and Dihydropyridines (Nifedipine, Amlodipine, etc.).
Verapamil is the only member of the Diphenylalkylamines class approved, while Diltiazem is the only member of the Benzothiazepines class approved in the US.
Dihydropyridines have a much greater affinity for vascular calcium channels than heart calcium channels, making them beneficial in treating hypertension.
Most CCBs have short half-lives (3-8 hours after oral doses), but sustained-release preparations are available for once-daily dosing.
Adverse effects include constipation (approximately 10% with Verapamil), dizziness, headache, and fatigue (more frequent with dihydropyridines).
Verapamil should be avoided in patients with congestive heart failure or atrioventricular block due to its negative inotropic effect.
β-Blockers (Propranolol, Metoprolol, Esmoprolol) are a treatment option for hypertensive patients with concomitant heart disease or heart failure.
β-Blockers primarily decrease blood pressure by reducing cardiac output.
Mlm Zebq (a type of mineral oil) and persistent low or high blood pressure can cause damage to the kidneys, heart, brain, and other organs leading to conditions such as chronic kidney disease, heart failure, and strokes.
Medications that lower blood pressure prevent these damages and significantly reduce the risk of cardiovascular events. Various classes of drugs are available for blood pressure management.
ACE inhibitors, such as Enalapril, Captopril, and Lisinopril, are recommended as first-line treatment for hypertension in patients with a high risk of coronary disease, diabetes, stroke, heart failure, myocardial infarction, or chronic kidney disease.
ACE inhibitors block the ACE enzyme responsible for producing the vasoconstrictor angiotensin II and decrease aldosterone secretion, leading to decreased sodium and water retention. They reduce both cardiac preload and afterload, decreasing cardiac work.
Common side effects of ACE inhibitors include dry cough, rash, fever, altered taste, hypotension, and hyperkalemia. The dry cough may be due to increased bradykinin levels in the lungs.
ARBs (angiotensin II receptor blockers), beta-blockers, CCBs (calcium channel blockers), diuretics (thiazides and thiazide-like diuretics), and other groups of drugs are also recommended for the treatment of hypertension.
The choice of medication is based on its proven ability to reduce blood pressure, evidence from placebo-controlled studies that they reduce cardiovascular events, and evidence of broad equivalence on overall cardiovascular morbidity and mortality.
ACE inhibitors, ARBs, beta-blockers, CCBs, and diuretics work by different mechanisms to reduce blood pressure and improve cardiovascular health.
The benefits of these classes of drugs in managing blood pressure far outweigh the risks, even in patients with chronic kidney disease, and their use is associated with improved cardiovascular outcomes and reduced mortality.

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Test your knowledge on the use of calcium-channel blockers as a treatment option for hypertensive patients with diabetes or angina, and learn about the classes of calcium-channel blockers and their potential risks.